[Practical management of Alzheimer's disease]

In patients with confirmed Alzheimer's disease--a condition for which no active treatment is available--the practitioner's first duty is to abstain from prescribing useless of harmful drugs that would make the situation worse. There is a long list of such potential nuisances. The most badly tolerated drugs unquestionably are anticholinergics, but one must also beware of tricyclic antidepressants, neuroleptics (sometimes unavoidable, however) and also, to a lesser extent, benzodiazepines, beta-blockers and so forth. Yet medical support is far from being ruled out. The benefits of placebos and drugs of undemonstrated value are not negligible, but above all it is mandatory to help the relative understand the truly pathological nature of almost unbearable behaviours. It is also very useful to advise the family on the life organization at home in order to perdure, on the legal safeguards, on whether or not the patient should be institutionalized, and similar topics. Inside institutions, keeping a sensible attitude between relentless therapy and euthanasia is the best way to ensure that the dignity of the demented patient will be preserved.